Kaiserin Elisabeth Spital, Vienna, Austria: flexible working practices
The Kaiserin Elisabeth Spital (KES) is a public hospital, part of the Viennese Hospital Association (Krankenanstaltenverbund Wien, KAV), which has 27 public hospitals and 30,000 employees, of whom 10,000 are nurses, 10% of them men. The KES has 240 nurses, women and men.
Vienna’s need for nurses to care for its ageing population faces pressure from restrictive health budgets and a lack of skilled nurses. The average age of nurses doing inpatient work in Viennese hospitals is 31 years and 85% of them are younger than 35 years. Nurses remain nine years in inpatient work, which means twice as long as their education time, and 90% do not leave at regular retirement age.
Traditionally most nurses leave inpatient work around the age of 35 years to continue in administration, management or teaching or to drop completely out of hospital work or even out of the profession. Thus, most nurses leave at the peak of their competence.
Formerly the KAV recruited nurses abroad. However, a strategy to maintain health services quality in Vienna is to keep experienced nurses doing inpatient work. Since 2000 KAV’s human resources (HR) policy for nurses has started to change from replacement to maintenance, by adjusting working conditions to the needs of ageing and multiethnic nurses.
The trade unions representing community workers play an important role in the KAV and every management decision is based on acceptance by the Trade Union of Community Workers. The works council of KES had a defensive policy, focused on prevention, early retirement and rest workplaces.
The original initiative
In 1997 the KES HR department implemented an age-management initiative that included measures to reduce the physical demands on ageing workers by cutting daytime shifts from 12.5 to 8–10 hours. The initiative’s aims were threefold:
- economic: reduce overtime and sickness costs;
- organisational: easier replacement;
- personal: better health and greater work ability, keeping experienced nurses longer.
The works council misinterpreted the initiative considering it as a step towards flexible working times, which they opposed, and thus refused to support it.
An evaluation of the measure in 1998 showed that although 60% of the nurses found shorter shifts better for personal health, and for their ability, physical and mental, to work, 71% preferred longer shifts. The preference varied with age: nurses older than 35 years preferred short shifts; nurses younger than 30 years long shifts.
The company redesigned the shift roster to include one long shift in every shift group, giving the nurses greater choice. It also provided information about ageing and work in order to educate workers about the benefits of adjusting work schedules to age.
An evaluation two years later in 2000 showed that 55% of nurses preferred short shifts. The results of the initiative are as follows:
- significant increase in ability to work, interest in work and quality of life;
- more time for patients and their families during afternoon shifts;
- reduced overtime costs;
- lower sickness absence rate.
Good practice today
In 1998 KES cut nurses’ day shifts to 8–10 hours while keeping night and weekend shifts at 12.5 hours. The new schedule was designed to maintain the work ability of older nurses by reducing the work load to match their capacity.
The new shift roster was also designed to reduce overtime costs and to keep experienced nurses doing inpatient work. Overtime costs and sickness absence rates decreased and nurses considered that the shorter shifts improved their ability, physical and mental, to work.
Nurses aged over 35 years preferred working with short shift while those aged under 30 years and those who lived far away preferred long shifts. Because of this the company implemented a revised shift roster that includes a long shift in every shift group, thus offering choice. The revised initiative includes the following
- shorter shifts to keep older nurses in the workforce;
- one or two long shifts in every shift group to provide choice;
- training for all nurses on ageing and the effects of life stages on ability to work;
- more responsibility for older workers.
Nurses work the new mixed-shift roster without conflict and its positive effects remain. The turnover of nurses aged over 35 years is much lower than in the decade before implementation, suggesting shorter shifts as an effective way to keep older nurses at work.
In this sense, the KES offers more attractive working time arrangements for older nurses. Trade unions and works council delegates support the new roster as it introduced a change in KAV’s policy approach towards ageing nurses, resulting in a new pension policy to discourage early retirement.
The KES has not implemented new initiatives for older nurses or other employees since 2001, partly because the company appointed a new director of nurses in 2004. However, the main reason was that the town’s councilwoman for health, a former physician, did not support initiatives for older nurses. New initiatives are expected as a result of a new KAV board of directors that includes the former director of nurses as general director for strategic human resources (HR) management.
In 2004 several hospitals outside the KAV group declared a state of emergency because of a shortage of nurses, which is expected to continue, so keeping experienced nurses at work will become even more important.
Waltraud Eigl, Deputy director for nurses (firstname.lastname@example.org)
Charlotte Staudinger, HR director for nurses in KAV (Phone: +43 1) 53114 0; email: STC@kav.magwien.gv.vt)
Rudolf Hundsdorfer, Chairman of trade union of county workers and member of City Council (Phone: +43 1) 31316 83611
Karazman, R., Staudinger Ch. (eds.), G esunde Arbeitszeiten im Pflegeberuf , Gamburg, G.Conrad Verlag für Gesundheitsförderung.